Physiology Section
DOI: 10.7860/JCDR/2014/7844.3983
Original Article
Effect of Yoga Therapy on Heart Rate, Blood Pressure and Cardiac Autonomic Function in Heart Failure
Bandi Hari Krishna1, Pravati Pal2, Pal G.K.3, Balachander J.4, Jayasettiaseelon E.5, Sreekanth Y6, Sridhar M.G.7, Gaur G.S.8
ABSTRACT Background and Objective: It is well known that a hall mark of heart failure is adverse changes in autonomic function. Elevated blood pressure is a powerful predictor of congestive heart failure and other Cardiovascular Disease (CVD) outcomes. In this study, we planned to examine the effects of a 12 week yoga therapy on blood pressure, heart rate, heart rate variability, and rate pressure product (RPP). Methods: Out of 130 heart failure patients recruited for the study, 65 patients were randomly selected to receive 12 week yoga therapy along with standard medical therapy (yoga group). Other patients (n=65) received only standard medical therapy (control
group). Heart rate, blood pressure, cardiac autonomic function (by short-term heart-rate variability analysis) and myocardial oxygen consumption (by RPP) were assessed before and after 12 weeks. In the yoga group, 44 patients and in the control group, 48 patients completed the study. Results: There was a significant decrease in heart rate, blood pressure and RPP in yoga group compared to control group. Also, LFnu and LF-HF ratio decreased significantly and HFnu increased significantly in yoga group compared to control group. Conclusion: Twelve-week yoga therapy significantly improved the parasympathetic activity and decreased the sympathetic activity in heart failure patients (NYHA I&II)
Keywords: Yoga, Cardiac failure, Heart rate variability
Introduction Heart failure is one of the major chronic illnesses responsible for a huge clinical and economic burden all over the world [1]. Based on disease specific estimates of prevalence and incidence rates of heart failure, the prevalence of heart failure in India due to coronary artery diseases, hypertension, obesity, diabetes and rheumatic heart diseases range from 1.3 to 4.6 million, with an annual incidence of 4,91,600-1.8 million [2]. Despite recent advances in pharmacologic and device therapy, morbidity and mortality from heart failure remain high [3]. Heart failure is associated with altered autonomic function [4]. There is markedly elevated sympathetic activity for a prolonged period in heart failure. Though less well documented, parasympathetic withdrawal is also an important facet of heart failure [5]. Elevated blood pressure is a powerful predictor for congestive heart failure and other CVD outcomes [6-8]. Yoga is a mind-body technique, which combines set of physical exercises (asana) in sync with breathing techniques (pranayama), relaxation and meditation. Yoga techniques produce a variety of beneficial effects on CVD [9-11]. It has been reported that yoga results in an improvement in lipid profiles [10], heart rate variability [12], decrease in blood pressure [11], RPP [13] and even regression of atherosclerosis when combined with dietary and other lifestyle modifications [14,15]. However, most of these studies are limited by lack of controls and varied types, intensities, and durations of yoga protocols used, making it difficult to compare and interpret results for heart failure patients. Hence, in this study, we planned to examine the effects of a 12 week yoga therapy on blood pressure (BP), heart rate (HR), heart rate variability (HRV), and RPP, since RPP is a measurable index of myocardial oxygen consumption and load on the heart [16].
Methods Following approval of the institute ethics committee, 130 heart failure patients were recruited from the cardiology outpatient department of Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry. Patients with systolic and/or diastolic dysfunction, having ejection fraction 30-50%, fulfilling 14
New York Heart Association (NYHA) class I-II criteria, able to walk without assistance and maintaining stable health condition on medical therapy were included in the study. Patients having chronic obstructive pulmonary disease, unable to attend yoga sessions, with orthopedic impediments to yoga, who were hospitalized within last three months and who had myocardial Infarction or recurrent angina within last six months were excluded from the study. Patients were randomly divided into two groups: 1. Control group (n=65), in which patients received standard medical therapy; 2. Yoga group (n=65), in which patients received 12 week yoga therapy along with standard medical therapy. However, 44 patients in yoga group and 48 patients in control group completed the study. Yoga Protocol Yoga sessions lasted for 60 minutes and were conducted thrice per week, for a total of 36 supervised sessions over 12 weeks. During each session, subjects practiced the following asanas and pranayama [Table/Fig-1]. Heart rate and blood pressure was recorded before and after each yoga session. Yoga sessions were conducted at ACYTER, JIPMER, by a yoga therapist with expertise in cardiac rehabilitation. Each session lasted around 60 minutes. After two weeks of participation in monitored sessions, they practiced the same for three days under direct supervision of the yoga therapist and three days at their home, for a total duration of three months. Modifications were made on an individual basis, according to each participant’s specific medical or orthopedic limitations. Chairs were used for those who were unable to stand up from the floor and the wall was used for support during the standing balance postures, as needed. Pranayama breathing exercises (breath awareness training) consisted of deep inhalation and exhalation in a 1:1 ratio, without breath retention. Inhalation was taught to begin with sequential involvement of the abdomen, lower chest, and then upper chest, with the same sequence in reverse, during exhalation. Meditation and relaxation practice was performed in a supine or seated position according to comfort level and participant’s preference. Journal of Clinical and Diagnostic Research. 2014 Jan, Vol-8(1): 14-16
www.jcdr.net
Sl. No.
Bandi Hari Krishna et al., Yoga Therapy for Heart Failure
Name of the Practice
Repetition
Duration (60 min) Approx
Sl. no
Parameter
Yoga Group % Change from Baseline
Control Group % Change from Baseline
p-value versus Control
15.53 ± 3.34
4.43 ± 3.26
DOI: 10.7860/JCDR/2014/7844.3983
Original Article
Effect of Yoga Therapy on Heart Rate, Blood Pressure and Cardiac Autonomic Function in Heart Failure
Bandi Hari Krishna1, Pravati Pal2, Pal G.K.3, Balachander J.4, Jayasettiaseelon E.5, Sreekanth Y6, Sridhar M.G.7, Gaur G.S.8
ABSTRACT Background and Objective: It is well known that a hall mark of heart failure is adverse changes in autonomic function. Elevated blood pressure is a powerful predictor of congestive heart failure and other Cardiovascular Disease (CVD) outcomes. In this study, we planned to examine the effects of a 12 week yoga therapy on blood pressure, heart rate, heart rate variability, and rate pressure product (RPP). Methods: Out of 130 heart failure patients recruited for the study, 65 patients were randomly selected to receive 12 week yoga therapy along with standard medical therapy (yoga group). Other patients (n=65) received only standard medical therapy (control
group). Heart rate, blood pressure, cardiac autonomic function (by short-term heart-rate variability analysis) and myocardial oxygen consumption (by RPP) were assessed before and after 12 weeks. In the yoga group, 44 patients and in the control group, 48 patients completed the study. Results: There was a significant decrease in heart rate, blood pressure and RPP in yoga group compared to control group. Also, LFnu and LF-HF ratio decreased significantly and HFnu increased significantly in yoga group compared to control group. Conclusion: Twelve-week yoga therapy significantly improved the parasympathetic activity and decreased the sympathetic activity in heart failure patients (NYHA I&II)
Keywords: Yoga, Cardiac failure, Heart rate variability
Introduction Heart failure is one of the major chronic illnesses responsible for a huge clinical and economic burden all over the world [1]. Based on disease specific estimates of prevalence and incidence rates of heart failure, the prevalence of heart failure in India due to coronary artery diseases, hypertension, obesity, diabetes and rheumatic heart diseases range from 1.3 to 4.6 million, with an annual incidence of 4,91,600-1.8 million [2]. Despite recent advances in pharmacologic and device therapy, morbidity and mortality from heart failure remain high [3]. Heart failure is associated with altered autonomic function [4]. There is markedly elevated sympathetic activity for a prolonged period in heart failure. Though less well documented, parasympathetic withdrawal is also an important facet of heart failure [5]. Elevated blood pressure is a powerful predictor for congestive heart failure and other CVD outcomes [6-8]. Yoga is a mind-body technique, which combines set of physical exercises (asana) in sync with breathing techniques (pranayama), relaxation and meditation. Yoga techniques produce a variety of beneficial effects on CVD [9-11]. It has been reported that yoga results in an improvement in lipid profiles [10], heart rate variability [12], decrease in blood pressure [11], RPP [13] and even regression of atherosclerosis when combined with dietary and other lifestyle modifications [14,15]. However, most of these studies are limited by lack of controls and varied types, intensities, and durations of yoga protocols used, making it difficult to compare and interpret results for heart failure patients. Hence, in this study, we planned to examine the effects of a 12 week yoga therapy on blood pressure (BP), heart rate (HR), heart rate variability (HRV), and RPP, since RPP is a measurable index of myocardial oxygen consumption and load on the heart [16].
Methods Following approval of the institute ethics committee, 130 heart failure patients were recruited from the cardiology outpatient department of Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry. Patients with systolic and/or diastolic dysfunction, having ejection fraction 30-50%, fulfilling 14
New York Heart Association (NYHA) class I-II criteria, able to walk without assistance and maintaining stable health condition on medical therapy were included in the study. Patients having chronic obstructive pulmonary disease, unable to attend yoga sessions, with orthopedic impediments to yoga, who were hospitalized within last three months and who had myocardial Infarction or recurrent angina within last six months were excluded from the study. Patients were randomly divided into two groups: 1. Control group (n=65), in which patients received standard medical therapy; 2. Yoga group (n=65), in which patients received 12 week yoga therapy along with standard medical therapy. However, 44 patients in yoga group and 48 patients in control group completed the study. Yoga Protocol Yoga sessions lasted for 60 minutes and were conducted thrice per week, for a total of 36 supervised sessions over 12 weeks. During each session, subjects practiced the following asanas and pranayama [Table/Fig-1]. Heart rate and blood pressure was recorded before and after each yoga session. Yoga sessions were conducted at ACYTER, JIPMER, by a yoga therapist with expertise in cardiac rehabilitation. Each session lasted around 60 minutes. After two weeks of participation in monitored sessions, they practiced the same for three days under direct supervision of the yoga therapist and three days at their home, for a total duration of three months. Modifications were made on an individual basis, according to each participant’s specific medical or orthopedic limitations. Chairs were used for those who were unable to stand up from the floor and the wall was used for support during the standing balance postures, as needed. Pranayama breathing exercises (breath awareness training) consisted of deep inhalation and exhalation in a 1:1 ratio, without breath retention. Inhalation was taught to begin with sequential involvement of the abdomen, lower chest, and then upper chest, with the same sequence in reverse, during exhalation. Meditation and relaxation practice was performed in a supine or seated position according to comfort level and participant’s preference. Journal of Clinical and Diagnostic Research. 2014 Jan, Vol-8(1): 14-16
www.jcdr.net
Sl. No.
Bandi Hari Krishna et al., Yoga Therapy for Heart Failure
Name of the Practice
Repetition
Duration (60 min) Approx
Sl. no
Parameter
Yoga Group % Change from Baseline
Control Group % Change from Baseline
p-value versus Control
15.53 ± 3.34
4.43 ± 3.26
